You don’t feel well today. Nagging cough, fever and you can hardly breathe. You pick up the phone and dial your doctor’s office number. What you get is a recorded message that tells you, among other things, that “if this is an emergency dial 911 or go to the closest hospital emergency room”. When you think that a live person finally answers, it’s a recorded message asking you to leave your name, birth date and the telephone you can be reached at and your call will be returned as soon as possible.

You are angry. You decide you’ll get to an emergency room. After several hours of waiting, blood drawing and chest Xrays, the emergency room doctor tells you that you have pneumonia and admits you into the hospital. You are relieved and can’t wait for when your doctor will come and see you.

Don’t raise your hopes too high. Your doctor will not come to see you. Instead a doctor you never knew existed will come to your room. He is the hospitalist on duty today!

If you were born after 1970, the likelihood is that you don’t know who Marcus Welby MD was. He was the principal character on a TV series which dominated the little screen from 1969 to 1976. Marcus Welby MD was a family physician who attended not only to the medical problems of his patients, but social and emotional problems as well. Not quite like today’s Obama care!

So what is a hospitalist? The hospitalist, according to Webster dictionary, is: “A physician who specializes in treating hospitalized patients of other physicians, in order to minimize the number of hospital visits by other physicians”.

In other words, care-payers do not want to receive bills from your doctor for hospital visits while you are hospitalized, by fear that your doctor may make too many visits during your hospital stay. Since the hospitalist is an employee of the hospital, he/she will not bill the insurance company for their work. The hospital will include it in your total hospital bill.

The hospitalist has come on the medical scene about 10 to 12 years ago, may be a little longer depending where you live.

The Websyer dictionary definition has changed with time so that it would not point to the reason why they are there. Currently it is defined as “Physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research and leadership related to Hospital Medicine”

Yes. It sounds much better than the Webster dictionary, that tells it like it is.

Mind you, I am not implying that hospitalists are no good. Like everything, you will find good, very good and excellent physicians among them. Their credentials and abilities are not the point of this discussion. What I object to is the depersonalization of medicine.

To be fair, part of what happens in the practice of medicine today, as it relates to the doctor-patient interaction, is the result of patients really not caring who takes care of them, as long as the bill is paid for by the insurance or the government. So perhaps I should not complain. But I do!

An important part of medical care is continuity, where by the doctor aims at knowing as much as possible about their patient. This knowledge is acquired over time not overnight. This is never the case with the hospitalist. They have no office, you can’t call him/her from your home, and you are not going to see him/her again once you are discharged. In fact it is most likely that you may not see your hsospitalist the next day, because he/she may have the day off. Another hospitalist will see you. And so it goes.

When discharged, you will be directed to return to your “family doctor” who will have to read your hospital chart or summary of your stay to see what happened to you.

Perhaps you don’t mind. Particularly if you are healthy and don’t need to be hospitalized. Just don’t complain if you need to be hospitalized and can’t keep track of who is caring for you. At least hope that there is no difference of opinion among the hospitalists on how to treat you, which may happen. If it does, the hospital probably has a “protocol” on how to treat a given condition. Unfortunately not all patients are the same even when having the same condition. If it works for 90% of the patients, you will be out of luck if you are in the remaining 10%. But that’s another story for some other time.
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SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so by email at: dr.aladjem@gmail.com

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